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A frequent deformation of the big toe
Hallus valgus is often seen in the summer. Otherwise, it remains hidden. It is commonly known as bunion. Malalignment of the forefoot in the form of a big lump on the metatarsophalangeal joint is more than just a visual defect. In many cases, it is an extremely painful problem that can only be remedied by surgery.
Hallux valgus is usually caused by shoes that are too tight. The main characteristics of the hallux are deformed big toe, which is bent towards the smaller toes (laterally), the pads on the inside of the metatarsophalangeal joint, the forefoot widening (splay foot), painfulness foot sole, the rotation of the big toe, and the accompanying deformations of the smaller toes.
As a rule, these complaints are initially treated conservatively, i.e. without a surgery, for example, using shoe inserts and bandages. If this is not enough, a surgical procedure becomes necessary.
When the big toe won't move
Osteoarthritis (cartilage wear) in the big toe joint can have several causes: Injury to the joint, circulatory disorder of the bone, or genetics. Unhealthy shoes (high heels) also cause wear. First, the rolling motion of the big toe is hindered. Pain occurs months or years later. Sometimes, you may feel a hardening of the metatarsophalangeal joint, which causes pain when you wear shoes.
In the early stage, the focus is on conservative, non-surgical treatments:
- Wear suitable shoes
- Cold applications (cryotherapy)
- Anti-inflammatory medications (ointments, pills)
- Physiotherapeutic treatment
- Orthopaedic measures (butterfly soles)
If the symptoms do not improve with the above-mentioned treatment options, a surgery becomes necessary.
If the big toe is increasingly pushing towards the smaller toe, there is no longer enough space for the smaller toes. They need to move upwards to make space for the big toe. This is a malposition of the toe with flexion in the middle joint and, usually, hyperextension of the metatarsophalangeal joint. The pressure of the bone underneath the skin of the middle joint results in a formation of painful, inflamed calluses. At first, the treatment consists of wearing soft shoes with special pads. An alternative is a surgery in which the toe is corrected.
Uncomfortable footwear or misaligned feet may irritate toe nerves, causing local nerve swelling (neuroma). This results in pain, sometimes even toe numbness.
The first treatment step is prescribing shoe inserts, physiotherapy, or injections of anaesthetics (so-called local anaesthetics) and cortisone. Alternatively, an injection therapy can be carried out with components obtained from patient's own blood, the platelet-rich plasma (PRP). If none of the symptoms improve, the nerve nodule can be removed during a small, minimally invasive operation.
A growth that extends between the heel and the toes is responsible for the formation of a heel spur. As the toes stretch, the tension of this growth increases. This leads to chronic irritation at the base of the heel bone and formation of a bony protrusion, the so-called heel spur.
If the pain is acute, the heel should be cooled and pain should be treated with anti-inflammatory pills (such as ibuprofen or diclofenac). Insoles with soft cushioning may also help. Shock wave therapy (ESWT) has also proven successful in the treatment of heel pain. It has been covered by the statutory health insurance funds since 2019 for the treatment of specific cases. Alternatively, an injection therapy can be carried out with components obtained from patient's own blood, the platelet-rich plasma (PRP). If all of the above does not help, the heel spur can also be surgically removed.
These injuries involve typical ankle changes that occur in athletes, particularly soccer players, at an advanced stage in their careers. Radiological changes, in the form of bony protrusions, appear on the talus (ankle bone) and the front tibia. They restrict mobility and cause entrapment when walking and moving. The patient often reports pain in the ankle joint area. Treatment often requires minimally invasive keyhole surgery, or the so-called arthroscopy.
Bone/cartilage injury is an acute condition that often occurs when the ankle joint is sprained. Small fragments of cartilage may move around in the joint, causing entrapment and restricting movement. They must be removed. Larger fragments are either fastened or, in extreme cases, removed, and the underlying bone is stimulated to generate replacement cartilage.
Tightness with impingement in the upper ankle joint is often seen following injuries. The concept of “meniscoid" is used for a thick fold of the mucous membrane between the tibia and the fibula as a result of tendon damage to the ankle. The results of minimally invasive surgery (arthroscopy) for the treatment of impingement are promising, with good to very good results in 75-90% of patients.